<p> Fetal Study/Report Checklist Fetal Studies</p><p>Is the study a complete initial examination?</p><p>Yes No</p><p>Does the study include the following standard views and images? (List below)</p><p>Yes No</p><p> presence of single or multiple gestations and the locations of fetus(s) relative to mother (and each other) survey of fetal lie and position defining fetal orientation measurement of biparietal diameter (BPD), head circumference or other measures for estimation of fetal size/gestational age fetal cardiac position and visceral situs measurement of chest and heart circumference and area for calculation of size ratios assessment of fetal heart rate and rhythm using appropriate M-Mode/Doppler techniques short axis view of fetal umbilical cord vasculature with spectral Doppler evaluation of flow in the fetal umbilical vessels and ductus venous imaging of the pericardial and pleural spaces, abdomen and skin for fluid or edema imaging and Doppler/color flow Doppler interrogation of the systemic veins, their course and cardiac connection imaging and Doppler/color flow Doppler interrogation of the pulmonary veins, their course and cardiac connection multiple imaging planes of the atria, atrial septum, foramen ovale, ductus arteriosus and ventricular septum, with appropriate Doppler assessment of flow direction and velocity multiple imaging planes of the atrioventricular (mitral and/ or tricuspid) valves, with appropriate Doppler evaluation “four-chamber” or equivalent and short axis views of the heart for assessment of cardiac chamber size and function. assessment of ventricular outflow and semilunar valves including the ventriculoarterial connections with appropriate Doppler/color flow Doppler short and long axis views of the ascending, descending and transverse arch of the aorta and ductus arteriosus with appropriate Doppler/color flow Doppler short and long axis views of the main pulmonary artery and proximal portions of the right and left pulmonary arteries</p><p>Does the study follow the facility specific protocol for components and sequence?</p><p>Yes No</p><p>Comments: </p><p>Evaluating Fetal Study & Report Checklist 1 (Updated 4-2017) Fetal Report</p><p>Is the following required demographic information present on the final report? (List below)</p><p>Yes No</p><p> date of the study name or initials of the performing sonographer name and/or identifier of the facility name of the ordering physician and/or identifier name and/or identifier of the patient documentation of estimated gestational age date of birth and/or age of the patient (EGA) and optionally, anticipated date and location of delivery indication for the study</p><p>Does the report include measurements performed in the course of the examination? </p><p>Yes No</p><p>Does the report include the Doppler values normal and abnormal obtained in the course of the exam?</p><p>Yes No atrioventricular valve integrity fetal lie and position aortic arch anatomy fetal visceral situs intracardiac and/or ductal shunting cardiac position and four chamber anatomy fetal hydrops great vessel relationships fetal heart rate and rhythm</p><p>Are the reported 2D/M-mode and Doppler measurements consistent with the quantitative and Doppler data?</p><p>Yes No</p><p>Is the report standardized in format with the other submitted final reports?</p><p>Yes No</p><p>Does the report include a summary of pertinent findings?</p><p>Yes No</p><p>Is the entire report typewritten?</p><p>Yes No</p><p>Is the identity of the interpreting physician present on the report?</p><p>Yes No</p><p>Is the report manually or electronically signed by the interpreting physician?</p><p>Yes No</p><p>Comments: </p><p>Evaluating Fetal Study & Report Checklist 2 (Updated 4-2017)</p>